1. how to avoid triggering a reactive or protective …...how to work with traumatic memory that is...

How to Work with Traumatic Memory That is Embedded in the Nervous System QuickStart #3 - pg. 1

1. How to Avoid Triggering

a Reactive or Protective

Response in

a Client’s Nervous System

While working to help our clients integrate their

traumatic memory, we may inadvertently

trigger dissociation. Here, Peter Levine, PhD

shares one important element to keep in mind

while working with a client’s traumatic

memories.

Dr. Levine: If you bring them all together at

once, boom, it explodes.

If a person is in a dissociated state, you need to

bring together the different sensations and

feelings and images and behaviors and

meanings, gradually. Again, if you do it too

quickly, they'll just dissociate again.

The key is because the trauma is so close to

what you're experiencing in the present, there is

no present. There is no now. There's only the

past playing over and over and over in the

present time.

So, we don't want flashbacks. We want to bring

one element of the experience together with

QuickStart Guide #3: How to Work with Traumatic Memory

That is Embedded in the Nervous System

by Ruth Buczynski, PhD;

with Pat Ogden, PhD; Bessel van der Kolk, MD; Peter Levine, PhD;

Ruth Lanius, PhD; Ron Siegel, PsyD; Bill O’Hanlon, LMFT; and Joan Borysenko, PhD


another element, so that you gradually start

putting the pieces of the jigsaw puzzle together.

Little by little. Because each time you put a little

piece together, there's a release of that energy

and then that energy can become assimilated.

Then another piece, and another piece, and

another piece. Piece by piece by piece. Slow

always wins (18:20-19:39, found on pg. 10 of

your Main Session transcript).

2. What to Look For to

Help Clients Break

Maladaptive Patterns

Trauma can create new procedural memories

that can actually extend the painful aftermath of

trauma. With this in mind, Pat Ogden, PhD

emphasizes the importance of training ourselves

to notice one key thing in our clients.

Dr. Ogden: We're looking for any habit in any

pattern. And these could be habits of posture

and structure. Like, somebody who this is the

way they go through the world. Their shoulders

are up. They're rigid. They don't have a lot of

flexibility or differentiation, as opposed to

somebody who goes through the world in other

postures.

Those are all procedural habits that reflect and

sustain working models, emotional patterns,


and past responses to trauma and attachment.

And I want to emphasize that it's very important

to remember that these procedural habits are

salubrious responses to the past.

The child grows up in an environment where the

parents expect them to be tough and strong. He

might develop a body that’s rigid, which is

adaptive in that environment, but later on,

when he gets married, his wife wants to go to

couples therapy because he can't soften.

So we look at habits and we train ourselves to

notice the physical habits (22:40-24:00, found

on pg. 12 of your Main Session transcript).

3. One Exercise to Uncover

Procedural Patterns

Procedural memory can be challenging for

clients to work with because it’s usually

happening at the unconscious level. Here, Pat

Ogden, PhD describes an exercise she uses with

students to uncover patterns of thought. This

exercise can also be used to help isolate areas

where traumatic memory has become self-

sustaining.

Dr. Ogden: One exercise that I often do with my

students is have them just mindfully, for five or

ten minutes, list all their thoughts in one column

of a paper. And then in the next column, start to


list and describe the functions of that thought.

Like, I'm judging myself. I'm planning for the

future. I'm ruminating over my mistakes.

Because that's the procedural element of

thinking – it's not what we're thinking; it's the

patterns (25:30-26:10, found on pg. 13 of your

Main Session transcript).

4. Two Ways to Release

Procedural Memories

When trauma traps a client in harmful patterns,

the therapist can serve as a mirror to show them

how trauma remains in their bodies. Now, how

do we use this new awareness to release these

procedural memories? Pat Ogden, PhD explains

two ways.

Dr. Ogden: One – you can stay with that

pattern, maybe even exaggerate it a little bit and

find out about it. Let it speak to you using

mindfulness. What does it feel like? What

happens to your breathing? Are there emotions

that go with it? Are there memories that go with

it? Maybe thoughts that go with it? So that's

one choice; stay with the pattern.

The other option is what we would call to

resource the pattern, to help him learn to take a

breath and let his shoulders drop.


So those are your two basic options. But I want

to caution against just shifting the body and

leaving the part of the client that is frightened

or hiding themselves, leaving that in the dust.

If we resource the pattern, we probably want to

go back to this part and have these two parts

start to communicate, so there can be

integration (33:31-34:31, found on pg. 17 of


5. Four Ways to Help Someone

Tolerate and Integrate

Traumatic Memory

Integrating traumatic memory can be key to

healing. But in order to integrate, a person has

to be able to stay with the dysregulation that

comes with trauma. Here, Pat Ogden, PhD and

Bessel van der Kolk, MD outline four different

ways to help people tolerate and integrate

traumatic memory.

NUMBER ONE

Dr. Ogden: We always want to track how the

person is already trying to resource themselves.

So this motion is a containing motion. It tightens

your arms and your back, and it contains, which

she needed. She needed containment.


So our first resource was to say, "Interestingly,

your body is already doing that... Let's play with

that. Can we stay with that a little bit?"

And then I do it with her, and we practice this

action. And that was her first resource that

helped her feel a bit more settled.

So one thing we do is that we watch the body –

see what the person is already doing to help

themselves calm down. We can capitalize on

that (42:30-43:19, found on pg. 21 of your Main

Session transcript).

NUMBER TWO

Dr. Ogden: Something I've found to be very

effective is to help clients be aware of what

they’re orienting to, both outside in the

environment and inside in themselves, because

clients who are traumatized start to orient

toward threat cues. And they start to orient

toward those cues of dysregulation inside

themselves.

I might give homework. “Go for a walk around

the block and just seek out things that bring you

pleasure in the environment — colors, the sky,

maybe birds, it could be even sounds.”

That’s helping retrain their orienting habits. And

then you do the same thing internally – ask

them if they can remember a time where they

felt good (or at least less bad), whether it's a

relationship or an experience in nature. And

then that becomes a new focal point of

orienting.


What's nice about both of these is that if you

orient towards pleasurable things in the world

or pleasurable things inside, your body starts to

respond (43:57-45:34, found on pg. 21-22 of


NUMBER THREE

Dr. Ogden: I like to spend time with clients on

appreciating their strengths – being able to

articulate the things that they are competent in,

because every single client is. And this is a

wonderful, wonderful way to start to transform

memory.

If somebody survived a trauma, they had

resources. Whatever they were, they had

resources. Even if they dissociated, that's what

we would call survival resources.

So when we work with memory, we'll go back

into that memory, searching for all the things –

the skills, the relationships – the ways they

handled it that were indicative of a strength.

And once a client realizes that, that memory is

never, ever the same. And that's what I think is

so wonderful (46:18-47:19, found on pg. 22 of


NUMBER FOUR

Dr. van der Kolk: Well, imagination is a central

human capacity that allows us to get to new

places. In some ways, imagination is everything.

As long as you cannot imagine anything other

than what is, you have nowhere to go. Opening


up people's imagination is a critical part of

trauma treatment.

If you have people imagine alternative ways of

what can happen – what would have happened

if you would have walked in this room the way

you are right now and would have seen what

your uncle was doing to this little kid? What

would you do today for that little kid? – a whole

new imagination pops in and says, "Oh, my god,

if I saw this happen to a kid, I would do the

following."

But when you're a kid, you do none of these

things. And so you juxtapose the two new

realities for people (48:38-49:52, found on pg.

23 of your Main Session transcript).

6. What Happens in the Brain

During a Flashback (And How to

Work Through It)

When a person has a flashback, they are

experiencing the past as the present. Here,

Ruth Lanius, MD, PhD shares one avenue that

can reconnect the brain and bring a person back

into the present.

Dr. Lanius: The critical part is to bring the

mindful brain online—that prefrontal cortex that


helps us to know where we are, have a sense of

time and know what we’re feeling in our body.

Because when people are in a flashback, they’ve

really lost that connection with those higher-

brain functions that help us to put everything in

perspective.

And so I think the way to reestablish some of

those connections is through sensory input –

using the five senses: Sitting on the chair what

do you feel? Do you feel your butt sitting on the

chair, touching the chair? Do you feel your arms

on the chair? What do you see?

And here again, I think the therapeutic

relationship can really be helpful: Look at me.

You’re safe here – bringing people back to the

present: You’re in the present. No one’s going to

hurt you here. Look at me. You don’t have to

make eye contact if you don’t want to, if it’s too

triggering, but just notice that I’m here with you,

you’re in my office, you’re safe, nobody’s going

to hurt you here.

Some people have favorite smells – a perfume

or some essential oils that they like to take out

and really help to bring them back to the

present through that sense of smell.

Different people have different ways of coming

back into the present, and what we do with

people is, we get them to create their own

“grounding kit” and so whenever they’re

triggered and whenever they lose touch with

the present, we help them to use the five senses


to bring them back into the present (5:29-7:21,

found on pg. 5 of your TalkBack transcript).

7. Strategies that Support

Gradual Healing

Working with someone who has experienced

trauma can be delicate work. Mindfulness

practices can be one way to ease clients into

treatment and help them avoid dissociative

symptoms. Here, Ron Siegel, PsyD shares a few

practices that can support safety and promote

integration.

Dr. Siegel: Most of the practices that foster or

facilitate safety are practices that would go right

into what Ruth (Lanius) described as her

“grounding toolkit” – things like walking

meditation where you’re paying attention to the

feet on the floor; listening meditation where

you’re listening to ambient sounds; nature

meditation where you’re looking at trees and

sky and the like.

There are also equanimity practices where you

imagine yourself being a mountain going

through seasonal changes with a sense of

continuity and stability to your “mountainness,”

even though there is a lot of change going on

around you.


And, there are also Marsha Linehan’s distress-

tolerance practices –things like holding an ice

cube and just discovering, I can be with this

discomfort. It’s okay. It’s safe to do that.

Now with things like lovingkindness and self-

compassion practices, we talked about the

danger of backdraft; how the feeling of love may

open the door to even more pain, so those

practices we have to go into judiciously (12:20-

13:29, found on pg. 8 of your TalkBack

transcript).

8. Two Resources to Help Process

Traumatic Memory

Because traumatic memory can often trigger a

reactive response in the nervous system, we can

start by helping clients feel safe enough to

revisit it. Here, Ruth Lanius, MD, PhD shares

two ways to resource a person to support

safety.

Dr. Lanius: Two of my favorite resources to get

people into before we do any type of processing

is sacred place (I don’t use the word safe place

because safe can be a trigger, especially if

people have never felt safe). A sacred place is a

place that is either real or imagined, that feels

completely sacred, where there are no

intrusions, where there’s no threat, there’s no


hurt. I often try to use a place in nature – and

get people to identify that.

So, what is a sacred place for them? What does

it look like? You know, whether it’s by a lake or

the sun is shining. I get them then to feel what

they feel in their body in the sacred place – so,

“Imagine feeling the warm sunshine in your

body.”

In order to get them to feel more grounded I

say, “Now, imagine standing barefoot in the

sacred place. Imagine the connection between

you and the ground. Imagine roots growing from

your feet into the ground. And just breathe.

Notice your breathing while you’re in the sacred

place, in and out.”

Another important resource is an attachment

resource. We’ve talked previously how

important attachment is in relationship to the

window of tolerance; how important

attachment is as a foundation for emotion

regulation; and of course how a lot of our clients

haven’t had that secure attachment figure.

So really going back – Is there any person in

their life who they’ve felt safe with? Or do they

want to use an animal? Or do they want to use a

higher being? – and then using that as an

attachment resource.

And we would work on getting the person in

their sacred place, imagining making eye contact

with either a person they felt safe with in their

life, or an animal, or a higher being –imagining


that sense of connection—and just being. And

repeating that over and over again so when you

get into the trauma work, you can call on these

different resources to either reduce the arousal

or enhance the arousal, so you’re staying within

the optimum window of tolerance and right at

the edge, and you don’t push people into too

much hyper- or hyperarousal (14:58-17:46,

found on pg. 9-10 of your TalkBack transcript).

9. One Strategy to Help

Integrate Conflicting Emotion

When a person can’t explicitly recall the details

of their traumatic experience, they can feel

deep and conflicting emotions. Bill O’Hanlon,

LMFT has one approach that can begin to help

us access these implicit memories and guide a

person to feel safe enough to revisit the trauma.

Mr. O’Hanlon: I use a particular kind of

hypnosis – not to go search for the memory, as

we were just talking about, but it’s more of a

permissive and gentle hypnosis, to create this

safe space for people to allow these

contradictory feelings and emotions that I’m all

messed up and I’m okay kind of thing.

Creating that safe space really starts at the

beginning of the hypnotic induction. So I might

say something like, “You can allow yourself to

be exactly where you are. There is no right way


or wrong way to experience this. Even if your

mind is telling you you’re not doing it right or

you need to relax, you can be tense – and you

could relax. You might feel vigilant and

apprehensive, or you might just feel trusting, or

you might feel both at the same time.”

So what I suggest is that you just allow yourself

room to have all those experiences or any of

those experiences – no right way or wrong way

to feel or think or be.

“Just allow yourself to be as you are. Maybe you

will remember something. Maybe you won’t

remember. You don’t have to remember, and

you can remember. And you can forget. You can

hold on to something and let go of something.

You can hold on in order to let go. And you can

let go in order to hold on.”

So I just go like that for a few minutes. And after

a while, people just seem to relax into it,

because I’m not taking a side: “Oh, you need to

remember,” or, “You need to feel good.” I’m just

allowing room for all of it. But I’m doing it in this

very rhythmic, soothing, permissive voice, and

after a while people seem to allow in whatever

needs to be in, in the nervous system. It calms

down the nervous system, and then sometimes

it’s a memory, sometimes it’s a change in

experience. But that’s what I do for about 15 or

20 minutes, and most of the time people find

something shifts in that time (6:28-8:52, found

on pg. 5-6 of your Next Week transcript).


10. Two Simple Techniques to

Keep Trauma in the Past

Trauma can make a person feel stuck in time—

like life will never change or get better. Bill

O’Hanlon, LMFT has two ways to help clients

regain a sense of time after experiencing

trauma.

Mr. O’Hanlon: I have two simple techniques,

and they are language techniques really. I put

the problem in the past tense and I put the

hopeful solutions and possibilities in the future

tense.

So, they’ll say, “I’m so depressed I can’t get out

of bed.” And I’ll say, “So you’ve been so

depressed you haven’t been able to get out of

bed very easily. So, when you’re able to get out

of bed, how will that make a difference, and

who do you think will notice first that

something’s better for you?”

So, I do future tense for the solutions, past tense

for the problems, and I continue to do that

through asking about the problem.

What I notice is a lot of my clients will say, “You

know, really we just talked about my situation

and nothing really changed, but I feel more

hope.”

And I think that’s partly because I’ve helped

them make that distinction between this is in

the past and this is in the future (7:15-8:18,

found on pg. 9-10 of your Next Week transcript).

1. how to avoid triggering a reactive or protective …...how to work with traumatic memory that is...

Documents